尼莫地平与高压氧对脑损伤后脑功能恢复的作用

背景尼莫地平对脑损伤后脑功能障碍的治疗已经得到肯定,而高压氧联合尼莫地平对脑功能障碍的治疗作用目前探讨者尚少.目的探讨脑损伤后脑功能恢复的有效的治疗方法.设计以诊断为依据,设立对照的回顾性研究.患者记忆商的测定采取双盲法.地点和对象华中科技大学同济医学院附属协和医院神经外科,对象为1997-07/2001-10华中科技大学同济医学院附属协和医院收治的110例额、颞叶挫裂伤非手术治疗的患者,选择格拉斯哥评分法评分在9～12分的患者,其中男83例,女27例.年龄18～73岁,平均43岁.所有患者均经头颅CT确诊.干预采用常规治疗和常规治疗分别加用尼莫地平、高压氧及尼莫地平和高压氧3种治疗方法,对110例脑损伤患者治疗,通过评价患者的记忆商、脑外伤综合征的程度,判断其脑功能恢复情况.结果常规治疗组的记忆商阳性率为73.5%,明显高于尼莫地平33.3%和高压氧28.6%及尼莫地平加高压氧治疗组28.6%,与分别加用尼莫地平、高压氧及尼莫地平和高压氧联合治疗组比较具有显著性差异(χ2=17.875 8,P＜0.001).常规治疗组脑损伤综合征的阳性率为65.6%,尼莫地平治疗组为28%,高压氧治疗组为28.5%,尼莫地平和高压氧联合治疗组为24%.常规治疗组与采用尼莫地平、高压氧及尼莫地平加高压氧治疗组比较差异具有显著性意义(χ2=14.015,P＜0.01).而尼莫地平、高压氧及尼莫地平和高压氧联合治疗组之间比较差异没有显著性意义(P＞0.05).结论脑损伤的患者,应用尼莫地平或高压氧或尼莫地平和高压氧联合治疗,对于脑功能的恢复具有十分重要的意义.

Brain functional recovery with the treatment of nimodipine and hyperbaric oxygen after brain injury

BACKGROUND: Although therapy of dysencephalia after brain injury with Nimodipine has been accepted, discussion on the therapy of dysencephalia with hyperbaric oxygen(HBO) and Nimodipine is still rare at present.OBJECTIVE: To explore an operative therapeutic method in brain functional recovery after brain injury.DESIGN: Contrast retrospective study was established based on diagnosis. Double-blind method was used in the assay of memory quotient of the patients.SETTING AND PARTICIPANTS: A total of 110 patients with contusion and laceration of frontotemporal lobe, who were not treated with operation, were selected from the inpatients of Neurosurgery Department of Xiehe Hospital Affiliated to Tongji Medicine College of Huazhong University of Science & Technology from July 1997 to October 2001. Their scores estimated by Glasgow Coma Scale were 9 to 12. There were eighty-three male cases and twenty-seven female cases. Their age range was 18 to 73 and average age was 43. All patients were finally diagnosed by skull CT.INTERVENTION: Four therapeutic methods were used: routine therapy,routine therapy plus Nimodipine,routine therapy plus Nimodipine and HBO,routine therapy plus HBO. Their memory quotients and the extent of cerebral trauma syndrome were detected to explore the brain functional recovery condition of these 110 brain-injured patients.RESULTS: The positive rate of memory quotient of routine therapy group was 73.5% . It was obviously 33.3% higher than that of Ninodipine group,28.6% higher than that of HBO group and 28.6% higher than that of Nimodipine plus HBO group. There always was significant difference when routine therapy group compared with Nimodipine group, HBO group and Nimodipine plus HBO group(χ2 = 17. 875 8, P ＜ 0. 001), respectively. The positive rate of cerebral trauma syndrome in routine therapy group was 65.6%, in Nimodipine group was 28%, in HBO group was 28.5% and Nimodipine plus HBO group was 24%. The significant difference was found in routine therapy group compared with Nimodipine group, HBO group and Nimodipine plus HBO group(χ2 = 14. 015, P ＜ 0.01), respectively. But no significant difference among Nimodipine group, HBO group and Nimodipine plus HBO group( P ＞ 0.05) was found.CONCLUSION: The application of Nimodipine or HBO or Nimodipine plus hyperbaric oxygen is of important significance for the brain functional recovery of patients suffering from brain injury.